Panel Recommends Routine HIV Tests For Teens, Adults

In a broad new expansion of HIV screening, an influential government panel now says everyone ages 15 to 65 should be tested for the virus that causes AIDS.

The draft recommendation, issued Monday by the U.S. Preventive Services Task Force, is far broader than its last recommendation in 2005, which called for screening only those at high risk.

"We really need to find the people who are infected and get them on therapy," says John Bartlett, a professor at the Johns Hopkins School of Public Health in Baltimore who wasn't involved in the new guidelines. "It will make their lives better. And once they're on treatment, they're no longer spreading the virus."

The task force's decision also could help people afford testing, says Carl Schmid, deputy executive director of the Washington, D.C.-based AIDS Institute, an advocacy group. Insurance companies sometimes base their payment decisions on grades issued by the task force. The group said its recommendation is based on grade-A-level evidence, the highest grade possibility, because of a "high certainty" of benefit. Under the Affordable Care Act, private insurers must cover all services that get a grade of A or B without co-pays. Patients can opt out of testing.

Although the Centers for Disease Control and Prevention has recommended routine HIV testing for adolescents and adults ages 13 to 64 since 2006, relatively few doctors routinely test patients today for HIV.

Only about half of adults have been tested, Bartlett says. And 20% of those with HIV don't know it.

The task force's recommendation could have a greater impact than the CDC's long-standing advice, Bartlett says, because these guidelines are aimed at primary care doctors, rather than the small number of specialists who treat AIDS.

Other task force recommendations have provoked controversy - such as its recommendations to give fewer mammograms and completely avoid the PSA test for prostate cancer. But Bartlett says the main question that infectious disease experts will have today is: Why didn't the task force act sooner?

The task force was influenced by new research showing the big health benefits of treating patients early in the course of infection, says task force chairwoman Virginia Moyer, a pediatrician at Texas Children's Hospital in Houston. In the past, she says, doctors lacked evidence that treating people early really made a difference.

Also, a landmark study published last year found that giving people anti-AIDS drugs reduces their ability to spread the infection by 96%, leading doctors to talk of "treatment as prevention."

Other research shows that people who know they have HIV reduce "risky behavior," such as sharing needles or having unprotected sex, by 25%, says Helen Koenig, an assistant professor of infectious disease at the University of Pennsylvania.

Many HIV patients learn their diagnosis only after being infected for years, the task force says. About one-third of newly diagnosed people with HIV progress to AIDS within a year of diagnosis, suggesting they could have carried the virus for a decade.

Moyer say she hopes that routine HIV screening will reduce the stigma of testing, so that patients don't feel singled out, and also encourage doctors. About 20% to 25% of people with HIV have no clear risk factors, such as intravenous drug use or gay sex.

"There really needs to be a lot of testing in people who don't think they're at risk," Bartlett says.

One of the most important risk factors for HIV, however, is poverty, with poor people having the highest rates of infection, Bartlett says.

Other public health campaigns have made huge differences in disease rates, says Bartlett, noting the USA's success in reducing the incidence of syphilis about 95%. Beginning in the 1940s, he notes, "you couldn't get married without the blood test, and it was used on all hospital admissions. That was one of the most magnificent disease eradication programs ever."

Some cities are already taking an aggressive approach to testing.

In Philadelphia, for example, public health workers offer late-night testing at gay clubs, as well as homeless shelters, soup kitchens and rehab centers, says Koenig, a clinician at the Jonathan Lax Center, part of a comprehensive AIDS service program called Philadelphia FIGHT.

But Koenig notes that testing is just the first step to stopping HIV and AIDS. More than 50,000 Americans are newly infected each year, and a total of 1.2 million are living with the virus.

The CDC has documented a "cascade" of obstacles that keep people from getting their virus under control, Koenig says. Many people remain undiagnosed; many of those who are diagnosed haven't seen a doctor; many of those patients fall out of care; and even those prescribed medications may not take them consistently.

Carlos del Rio, a professor at the Emory School of Public Health in Atlanta, says he hopes primary care providers quickly add HIV testing to their routine.

"We're not very good as clinicians at figuring out who is infected," del Rio says. "A lot of doctors are still uncomfortable with HIV. People say, 'People in my community do not have HIV.' "